| BackgroundIn recent years,the incidence rate of lung cancer has always been high.At the same time,the high mortality rate and the great difference in treatment effect under different stages,leading to timely diagnosis and treatment of early lung cancer is very important for improving prognosis..Non small cell lung cancer(NSCLC)is one of the most common pathological types of lung cancer.If early treatment intervention is carried out,the prognosis of NSCLC is significantly better than that of advanced NSCLC.At the same time,lymph node metastasis is one of the important indicators of NSCLC staging and one of the important factors affecting its prognosis.It also plays a key role in guiding how to treat it.Therefore,it is urgent to identify whether lymph node metastasis exists in early NSCLC.At present,CT is the main method to identify early NSCLC,but due to the expensive price of PET-CT and the fact that there are not too many lymph node metastasis in early NSCLC,PET-CT is not suitable as a routine examination to judge lymph node metastasis of early NSCLC.At the same time,with the increase of the detection rate of early NSCLC,the number of lymph node metastasis gradually increased.However,there is no clear CT and other indicators to more accurately identify whether early NSCLC has lymph node metastasis.In this study,we selected the preoperative diagnosis of clinical stage I non-small cell lung cancer and after surgical treatment of the population as the sample,further mining and clinical stage I NSCLC patients with lymph node metastasis related parameters,and its risk prediction,in order to provide a theoretical basis for clinical stage I NSCLC patients to judge whether they have lymph node metastasis before surgery.ObjectiveObjective to study and analyze the related risk factors of lymph node metastasis in patients with stage cI NSCLC diagnosed preoperatively and confirmed by postoperative pathology,so as to deepen the understanding of lymph node metastasis in patients with stage cI NSCLC,in order to achieve more accurate clinical staging and more precise diagnosis and treatment plan.It also provides a theoretical basis for surgeons to select the appropriate method of lymph node dissection for patients with early non-small cell lung cancer.MethodsThis study retrospectively analyzed the clinical data of 354 patients with clinical stage I non-small cell lung cancer who underwent thoracoscopic assisted radical resection in the Department of thoracic surgery of the First Affiliated Hospital of Zhengzhou University from August 1,2017 to August 30,2020 The clinical data,such as age,gender,tumor size and tumor density,were statistically analyzed by IBM SPSS Statistics 25.0,in order to find out the parameters related to lymph node metastasis in patients with clinical stage I NSCLC and carry out risk factors.ResultsAmong the 354 patients diagnosed as clinical stage I NSCLC preoperatively and confirmed as NSCLC postoperatively,67 patients had lymph node metastasis(18.93%).Among them,16 cases(23.88%)only had intrapulmonary/hilar lymph node(N1)metastasis,51 cases(76.12%)had mediastinal lymph node(N2)metastasis,and 26 cases(50.98%)had mediastinal lymph node skip metastasis.Gender(P=0.011),history of cardiovascular disease(P=0.012),preoperative CT maximum diameter of tumor(P<0.001),the proportion of solid components in tumor(P<0.001),mean CT value of tumor(P<0.001),differentiation degree of tumor(P<0.001)and pleural invasion(P<0.001)were associated with lymph node metastasis.Through further analysis of the related factors,the proportion of solid components in tumor(P<0.001),differentiation degree(P<0.001)and pleural invasion(P=0.021)were the independent risk factors for lymph node metastasis.354 patients with clinical stage I NSCLC were further divided into two groups.group A(51 patients):patients have mediastinal lymph node metastasis,group B(304 patients):patients have no mediastinal lymph node metastasis.The results showed that gender(P=0.043),history of smoking(P=0.020),history of cardiovascular disease(P=0.024),preoperative CT maximum diameter of tumor(P<0.001),the proportion of solid components in tumor(P<0.001),mean CT value of tumor(P<0.001),tumor differentiation(P<0.001)and pleural invasion(P=0.001)were associated with lymph node metastasis in patients with clinical stage I NSCLC.The independent risk factors were the proportion of solid components in tumor(P=0.002),differentiation degree of tumor(P=0.001)and preoperative CT maximum diameter of tumor(P=0.047).At the same time,preoperative CT maximum diameter and degree of differentiation were the more important risk factors for mediastinal lymph node metastasis.ConclusionGender(P=0.011),history of cardiovascular disease(P=0.012),preoperative CT maximum tumor diameter(P<0.001),the proportion of solid components in tumor(P<0.001),CT mean value(P<0.001),tumor differentiation(P<0.001)and pleural invasion(P<0.001)were associated with lymph node metastasis,and gender(P=0.043),history of smoking(P=0.020),history of cardiovascular disease(P=0.024),preoperative CT maximum diameter of tumor(P<0.001),the proportion of solid components in tumor(P<0.001),mean CT value of tumor(P<0.001),differentiation degree of tumor(P<0.001)and pleural invasion(P=0.001)were associated with the patients who have mediastinal lymph node metastasis and were diagnosed as clinical stage I NSCLC.The proportion of solid components in tumor(P<0.001),differentiation degree(P<0.001)and pleural invasion(P=0.021)were the independent risk factors for lymph node metastasis,and the proportion of solid components in tumor(P=0.002),degree of differentiation(P=0.001)and preoperative CT maximum diameter of tumor(P=0.047)were independent risk factors for mediastinal lymph node metastasis. |
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